The US prison system has become an important front in the effort to control HIV. The increase in drug-related sentencing over the last 20 years has resulted in significantly increased concentrations of offenders with HIV and HIV-related risk factors. The US correctional system serves as the principal screening and treatment venue for millions of individuals with or at high risk for HIV infection who are out of the conventional community-based health care system's reach. Many offenders are offered HIV testing for the first time while incarcerated, and three-quarters of inmates with HIV infection initiate treatment during incarceration. The majority of incarcerated HIV-infected offenders respond well to antiretroviral therapy and demonstrate high levels of adherence to complex antiretroviral drug regimens during incarceration. Many ex-offenders, however, discontinue their treatment following release from prison. These individuals are at increased risk of developing drug-resistant disease and resuming high-risk behaviors, potentially infecting others and creating reservoirs of drug-resistant HIV in the general community. Psychiatric disorders may serve as a significant barrier to HIV- infected offenders' failure to establish and maintain clinical care following release from prison. Because the vast majority of offenders are incarcerated for less than 3 years, identifying and understanding the extent to which psychiatric disease serves as a barrier to establishing and maintaining effective HIV outpatient care planning holds far-reaching public health relevance. To date, no published information is available on this critically important issue. We propose a historical cohort study to assess the extent to which having a psychiatric disorder decreases the likelihood of establishing and maintaining outpatient care among newly released HIV-infected Texas Department of Criminal Justice (TDCJ) offenders. Our study cohort will consist of approximately 1,200 HIV-infected offenders who were released from the TDCJ between January 1, 2004 and December 31, 2006 and were referred to HIV outpatient care in Harris County, TX. This study will rely on electronic clinical, pharmacy, and demographic data from 3 sources: 1) the TDCJ electronic medical record system, 2) the Harris County Centralized Patient Care Data Management System (CPCDMS), and 3) the Texas Department of Health (TDH) Texas HIV Medication Program (THMP) database. Specifically, we will examine whether ex-offenders with psychiatric disorders are at increased risk of the following outcomes in comparison to ex-offenders without psychiatric disease: 1) poorer rates of initiating outpatient clinical care; 2) poorer overall clinical outcomes (CD4 count, virus load, AIDS-indicator diseases); 3) poorer retention in outpatient care; and 4) higher recidivism rates. Recent reports indicate that HIV-infected prison inmates adhere to antiretroviral therapy and have positive treatment results during incarceration, but these effects are not sustained following their release into the general community, indicating that a large proportion of offenders stop HIV treatment following their release from prison. Given that psychiatric disorders constitute a substantial barrier to HIV treatment adherence in nonincarcerated populations, it is likely that they also play a major role in treatment non- adherence in released offenders. Because the majority of offenders are incarcerated for less than 3 years, identifying and understanding the extent to which psychiatric disease decreases the likelihood of establishing and maintaining effective HIV outpatient care following release from prison is an important public health issue. [unreadable] [unreadable] [unreadable]